Question 1

What is HCPCS code L5679?

Accepted Answer

HCPCS code L5679 is "Socket insert w/o lock mech". Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism

Question 2

What category is L5679 in?

Accepted Answer

L5679 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L5679?

Accepted Answer

Use L5679 when billing for socket insert w/o lock mech. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is L5679 covered by Medicare?

Accepted Answer

Coverage for L5679 (Socket insert w/o lock mech) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for L5679?

Accepted Answer

Documentation for L5679 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).